What are the Pelvic Floor Muscles?
If you look at a picture of the pelvic bones, you will notice that the bottom of the pelvis is empty. What, then, prevents our internal organs from falling to the floor? Our pelvic floor muscles.
If you were to look up at the pelvic bones from a position on the ground, you’d see a diamond shape formed by the pubic bone in front, the coccyx (tailbone) in back, and the sitz bones on the sides. The pelvic floor muscles attach to the four points of this diamond.
What Do the Pelvic Floor Muscles Do?
The pelvic floor muscles support the internal organs and form the sphincters that control urination and defecation. In women, the pelvic floor muscles play a role in childbirth. In addition, while the pelvic floor muscles only move the bones of the pelvis a very little bit, that very little bit turns out to be critical for walking.
How Do I Engage the Pelvic Floor? It Seems Very Difficult
The pelvic floor muscles are among the most difficult muscles to access. With the big movement muscles, it is easy to picture what they are doing, and to know if you are using them correctly. For example, to contract the biceps, turn your palm face up and bend your elbow to bring your hand toward your shoulder. You can see your arm moving, and if you put your other hand on the front of your upper arm, you can feel biceps contract. In contrast, when you contract the pelvic floor muscles, you can’t see anything moving at all, unless you have an ultrasound machine. It can also be very difficult to feel the muscles contracting, although with practice it does get easier to feel them.
So if someone tells you to engage the pelvic floor, what are you supposed to do? As a first step, imagine that you are contracting the pelvic muscles that would cut off a stream of urine, or that would prevent you from passing gas. An important note of warning: actually practicing cutting off the stream of urine while in the toilet is not a good way to practice engaging the pelvic floor muscles, because doing so can interfere with proper functioning of the bladder.
What Can Go Wrong With the Pelvic Floor?
A poorly functioning pelvic floor can result in incontinence. Incontinence, especially urinary stress incontinence (wetting a little bit when coughing or sneezing), is extremely common. Because of differences in the pelvic floor anatomy and because of childbirth, women are more likely to suffer from incontinence than men.
The good news about incontinence is that it can typically be treated very successfully with a program of pelvic floor exercises. For treatment of incontinence, it is important to see a qualified physiotherapist with special training in pelvic floor issues.
Cutting edge research is also now suggesting that pelvic floor dysfunction can also be involved in lower back pain.
How Do I Know if I am Engaging My Pelvic Floor Correctly?
As we mentioned above, it is very difficult to know if you are engaging your pelvic floor correctly, because neither you nor your Pilates instructor can see it working or palpate (feel) it. However, a physiotherapist with special qualifications in pelvic floor issues does have the tools (typically ultrasound equipment) and the training to diagnose pelvic floor problems. If you are suffering from incontinence, or have other reason to be concerned that your pelvic floor is not functioning correctly, please see a physiotherapist with special qualifications in pelvic floor issues.
